NEGLECT AND PROBLEMS TAKING CARE OF THE ELDERLY JAPANESE

TAKING CARE OF THE ELDERLY IN JAPAN

Married women are often expected to take care of their parents when they are sick or near death. The experience can be extremely stressful and it is not uncommon for women to come down with autonomic ataxia, a condition brought about by severe stress that can produce chronic fever, achy limbs, permanent exhaustion and difficulty swallowing.

In the old days caring for the elderly was not an issue. It was assumed their families would take care of them. One Japanese aging expert told the Washington Post, "Since around 1980, many parents and kids have stopped living together. Women are working outside the home; the young ones are starting to keep their own name. Before, when parents got sick, it was the job of the [eldest son's wife] to do the 'final care' for her in laws. There was no question about it. That was her job."

Many elderly people who took care of their parents resent not being taken care of by their children. Even though their children welcome them to move in the elderly people balk at the offer because they don’t want to be a burden and don’t want to live as a guest and be anything less than the boss. Those that do move in with their children often prefer to move in with the daughters instead of their oldest sons.

Many people responsible for caring for elderly grandparents are in their fifties, sixties and seventies themselves. In a survey of Japanese high school students, only 15.7 percent said they planned to care for their parents in old age (compared to 66.2 percent of Chinese students).

One in Ten Seniors in Japan Suffers from Dementia

In August 2012, the Yomiuri Shimbun reported: “More than 3 million elderly people across the nation suffer from dementia, double the number 10 years ago, according to a health ministry estimate. This means one in 10 people aged 65 or older suffer from the condition---a sharp increase that is far worse than the Health, Labor and Welfare Ministry's earlier estimate. [Source: Yomiuri Shimbun, August 25, 2012]

The survey was the first of its kind since 2002, when dementia patients numbered 1.49 million, and estimates how many seniors suffering from dementia require some kind of daily assistance. Its estimate was calculated using 2010 nursing care insurance data on the number of certified cases of people in need of long-term care. [Ibid]

According to the survey, this number reached 2.8 million in 2010, or 9.5 percent of the population aged 65 or older. The number will rise to 3.45 million in 2015 (10.2 percent of the elderly population), 4.1 million (11.3 percent) in 2020 and 4.7 million (12.8 percent) in 2025, according to the survey. A 2002 survey estimated the number of dementia patients in 2010 would be about 2.08 million, or 7.2 percent of senior citizens, and 3.23 million, or 9.3 percent, in 2025. [Ibid]

One factor behind the sharp increase appears to be the rapid aging of society. Another is the increasing number of people visiting hospitals thanks to increased public awareness of the condition. In response to rising public interest, more doctors have become able to correctly diagnose dementia in patients. [Ibid]

Lonely Old People in Japan

In 2003, 3.24 million Japanese 65 or older were living alone. Most had lost their spouse. Some were divorcees. In many cases they rarely saw their children.

These days more and more old people are choosing to live alone, in many cases because they don’t want to be a burden to their families. The National Institute of Population and Social Security Research estimates that 30 percent of Japanese 65 and older live alone and that figure is expected to rise to 40 percent by 2030.

In one survey, 24 percent of men over 65 living alone said they had no contact with their neighbors. One 78-year-old woman living alone to the Asahi Shimbun, “If something happened to me, I’m afraid that nobody would notice.”

Since the end of World War II the nuclear family has been steadily replacing the traditional Japanese extended family that often had three generations, even four generations living under one roof. The number of three-generation households decreased from 56 percent in 1972 to 29.7 percent in 1999.

Alcoholism is becoming a problem among the elderly, Between 1997 and 2007 the number of people over 60 seeking treatment for alcoholism increased by 40 percent. Many blame retiremenlt, saying elderly people turn to the bottle to fill the extra time they have on their hands.

Some companies have come up with high-tech solutions to keeping an eye on the elderly. Security services have installed monitors in the home of elderly people living alone and relay data to the cell phones of their children to let them know if the elderly parent has left the house or is otherwise moving around.

'Lonely Deaths' among Elderly, Disabled Rising

In March 2012, the Yomiuri Shimbun reported: “The number of multiple unnoticed deaths in households in which an adult cares for an elderly parent or a family member takes care of a disabled relative has been increasing recently. Such cases are believed to be partly attributable to isolation resulting from a breakdown in community ties. So-called lonely deaths are becoming a serious social concern and raise the question of what can be done about the problem. [Source: Eiji Kaji and Shumpei Takeuchi, Yomiuri Shimbun, March 26, 2012]

In December 2011, a 77-year-old mother and her 44-year-old seriously disabled son were found dead in their house in Asahi Ward, Yokohama. About one month before, the mother had told a neighbor that she was exhausted. Her husband died in July last year. The son had commuted to a welfare facility for 25 years, but in September the mother reportedly had him stop and began taking care of him on her own. She left a neighborhood association, saying she could not take her turn as director, and the family gradually lost ties with the local community. The mother and son died of disease at about the same time. [Ibid]

In March 2012, in Tachikawa, Tokyo, a 95-year-old mother and her 63-year-old daughter who cared for her were found dead in an apartment run by the Tokyo metropolitan government. It was estimated they had been dead for one month. In many cases, a family member who cared for an elderly parent or a disabled relative died of disease first, leaving the survivor, who later died without care. [Ibid]

cording to Tokyo Metropolitan Housing Supply Corporation, there have been about 400 unnoticed deaths a year in single-person households in recent years in its approximately 260,000 public-housing units. The number of unnoticed multiple deaths in our units with two or more tenants indicates a blind spot in our monitoring system," an official of the corporation in charge of the public apartments said. [Ibid]

In 2011, the Tokyo-based NLI Research Institute estimated that a little more than 15,600 persons aged 65 or older die every year without their deaths being noticed for at least four days. The estimate was based on an extrapolation from the number of similar cases in Tokyo's 23 wards handled by Tokyo Medical Examiners' Office. [Ibid]

e town government of Kikuyo, Kumamoto Prefecture, distributed cards bearing emergency contact numbers and telephone numbers of family doctors to elderly people living in the prefectural Musashigaoka Danchi apartment complex. ccording to the town's social welfare council, the measure has been effective. In one case, an elderly person who collapsed outdoors was carrying the card, allowing family members to be contacted. [Ibid]

of. Katsufumi Matsunohana of Momoyama Gakuin University, who specializes in social welfare, said: "Neighbors don't notice anything [in such cases]. Part of the problem is that whole families become isolated from society. It's important to notice even minor changes concerning residents of local communities even though it may appear meddlesome.” [Ibid]

Aging Poverty in Japan

There is a growing number of poor seniors in Japan. Between 1995 and 2005 the number of indigent elderly increased 183 percent to around a half million people, many of whom have effectively been abandoned their children. Many people in the field say the half million figure is a gross underestimate and the real figure is around five times higher.

Housing complexes for the poor are often filled with elderly people. Almost half of all welfare beneficiaries are 65 or older. By contrast in the United States one in 10 are. Some receive nothing because they homeless and the government requires them to have a fixed address to get assistance. Others are too embarrassed or ashamed to apply for it.

The elderly have been hurt by welfare cuts. Some get by on rice and noodles, keep the heat off even in mid winter to save energy costs. and have given up going to weddings and funeral because they can’t bear the shame of not being able to offer a present. See Welfare,

Elderly, Crime and Prison in Japan

There are reports of elderly people turning to crime out of poverty and isolation. The majority of the crimes committed are shoplifting and petty theft. There are even reports of lonely old people committing crimes with the aim of getting caught and sent to prison, where their needs are taken care of.

A record number (48,605) of senior citizens were arrested in 2007. Of the 31,573 arrests recorded for theft, 25,834 were for shoplifting, 82 percent involving elderly women pilfering items from stores. The next most common crime among the elderly was embezzlement (10,672 cases).

The proportion of total crimes committed by the elderly jumped from 2 percent in 1988 to 13 percent in 2007, with the number of arrest involving the elderly increasing fourfold between 1997 and 2007. The trend is blamed in the increased isolation and financial troubles faced by elderly people.

About 24 percent of elderly people who get caught shoplifting in the Tokyo area say they ,”teal because they are lonely.” Nearly 100 elderly people in Tokyo were charged with illegally capturing and keeping wild birds, such as white eyes, a kind a sweet-singing warbler. Many of those who caught the birds said they did it because they were lonely.

The elderly, particularly those living alone and suffering from dementia, have been targeted by con artists using a number of scams that include the sale of expensive health appliances and signing contacts for expensive but unnecessary house renovations. In Tochigi Prefecture, police arrested 17 people involved in a fraudulent home repair scam. In some causes they poured water from plastic bottles they brought with them under houses and then told the homeowners they needed to repair leak pipes. According to police one elderly man was unable to buy food because he spent all of his money on repairs and one woman had been hit up by the same company a number of times.

Aging Prisoners in Japan

Japanese prisoners are aging along with the general population. New jails being built to accommodate them that have wheelchair ramps, grab-bar toilets and baths, and more healthy meals. The number of prisoners over 60 rose from 17,942, 19.3 percent of the that prison population in 2000 to 46,637, 59.3 percent o the prison population, in 2006

Onomichi Prison has a special ward for older prisoners. Adjustments made for the older prisoners include relaxing requirements that they march in formation, providing low-sodium dishes at meal time, and cutting New Year,” rice cakes into small pieces so they don’t choke. No figures have been released on the cost of taking care of these prisoners but health care alone is thought to be a major burden.

Studies have found that after being released older prisoners are mor likely to end up back in prison, presumably because they have nowhere else to go. Most of those sent back are sent back for committing nonviolent crimes sch as shoplifting or petty theft. When they leave prison they often can not find work and without work or a guarnteer they cannot rent an apartment.

The director at Ominichi Prison told the New York Times, “There are some elderly who are afraid of going back into society. If they stay in prison, everything is taken care of. There are examples of elderly who’ve left prison, used what money they had, were arrested after shoplifting at a convenience store. They’d made up their minds to go back to prison.”

One 71-year-old inmate imprisoned for mugging a woman to pay for gambling habit told the New York Times, he found prison life to be “much better than expected.” He said, “it sounds strange, but we’re all old folks here. I’m old, too, and we’re all pretty quiet.” Many of the prisoner save been disowned by their families and receive few visitors.

Neglect, Abuse and Abandonment of the Elderly in Japan

With the decline of Confucian values, which made care of the elderly a top priority, and the high cost of simply taking care of one's immediate family, many elderly people are being ignored and slipping through the cracks.

Attention was focused on the issue in the mid-1990s after an elderly couple living a car were found dead from starvation and man in his 50s was found his downtown apartment in Tokyo a year and a half after he died. The elderly woman who starved to death wrote in her diary, "We didn't ask for much. What we wanted was just an ordinary life. What have we done? Why did we have to suffer so much?"

In September 2007, a 53-year-old man in Maebashi was arrested on charges of neglecting his elderly mother who died. The son abandoned his mother, who suffered from heart disease and had difficulty walking. When police arrested him the man said, “I’m tired of taking care of my mother.”

Abuse of the elderly is on the rise, with 12,569 such cases reported in 2006. A total of 15,615 cases of elderly abuse by members of their own family were reported in fiscal 2009, a 4.9 percent increase from the previous year.
Many cases involves mothers being taken care of by a formerly dependent son. In one case, a 74-year-old woman was found sleeping a garden to escape violence by her 47-year-old son. She was hospitalized with pneumonia, rib fractures and colon-rectal cancer and died soon after she was admitted.

Breakdown in Traditional Care for the Elderly in Japan

On why the elderly are sometimes neglected in modern Japan, Harvard,” Michael Sandel told the Yomiuri Shimbun: “ I think part of the explanation is that contemporary market societies have achieved a great deal of good, as we see with rising levels of affluence. But the individualism, the sometimes extreme individualism associated with market societies, poses a challenge to community and social cohesion. So what I think we need is a public debate that addresses not only the economic but also the moral dimensions of modern social life in market societies.”[Source: Yomiuri Shimbun, January 16, 2011]

“I think what we need to work out is a sense of shared responsibility as a community for the elderly members of the community. If they're not being cared for by the extended family structure, we need to work out a new system of care and responsibility that the community agrees to as part of its understanding of the common good. We have to work out a shared understanding of the common good that reaches across generations, so that there is a communal responsibility for the elderly to help make up for the shift from an extended family structure to a nuclear family structure.” [Ibid]

“We need to build new structures of community and a new understanding of the common good, so that it is understood that there is a communal responsibility for the elderly, and that requires a kind of public discussion, and the solution may vary in one region to another how best to work this out. Whether to create communal living facilities that are supported to provide care for the elderly: Different communities, different regions, may work out the details differently.” [Ibid]

Help for the Elderly in Japan

Some communities have formed organizations to watch over residents who are 65 and older, in some cases with some assistance coming from local governments. Many government-owned apartments with elderly living in them have installed motion-detecting sensors that help keep track of activity in the apartment building.

In the absence of sons and daughters, much of the care has been meted out to caregivers outside the family who themselves are getting on in years, a phenomenon known as rorokaigo. A former community safety official responsible for looking out for his elderly neighbors told the Los Angeles Time, "This work is very hard...My son moved away. Women can't do it. So it's up to me." [Source: Mark Magnier, Los Angeles Times, March 22, 2011]

A lot of time, energy and technology in Japan has gone into making sure the elderly are well-taken care of. well. Mark Magnier wrote in the Los Angeles Times: “Electronics companies are developing robots that talk to and do chores for them, including Riba, an electronic nurse that lifts people out of bed. Car companies have crafted large-print dashboards and easy-exit swivel seats, while toilet-maker Toto is working on medical commodes that transmit daily urine and stool analysis data from isolated communities to distant medical centers. A tea kettle with wireless technology can warn distant offspring if a parent doesn't use it every morning, a warning to call in.” [Source: Mark Magnier, Los Angeles Times, March 22, 2011]

An increasingly large percentage of the customers at game arcades in Japan are elderly. In some places 30 percent of the customers are 60 and over. This is both a product of the elderly having a lot of free time and are looking for something to do and young people using the arcades less. One of the more popular games among the elderly is a medal game in which players try to collect medals that allow them to play more games.

In Kumamoto Prefecture senior welfare centers are using arcade games in the rehabilitation and health maintenance of the elderly. Taiko no Tatsujun (drum master) is a popular game. The Asobi Re park facility in Kumamoto, set up in 2006, welcomes more than 10,000 elderly people a year. There are examples of elderly who walked in with a cane before playing the games there who didn’t need the canes afterwards.

Saeko Yoshida is a leader in making barrier free homes for the elderly. Among her ideas are bathrooms with removable walls that allow people in wheel chairs to be easily moved from the bathroom to living room and rooms filled with natural light to aid those with cataracts.

When the Elderly Take Care of the Elderly

What happens when relatives who must care for the elderly at home are elderly themselves? The case of physicist Fumiko Yonezawa, 72, is instructive. Yonezawa, who lives in Tokyo, and her 70-year-old sister, who lives in Osaka, provide nursing care for their 93-year-old mother, Toshiko, in Osaka. In an interview with The Yomiuri Shimbun, Yonezawa said although caring for the elderly can be physically and emotionally exhausting, she wants to cherish every moment she spends with her mother. [Source: Mieko Furuoka, Yomiuri Shimbun, October 9, 2011]

A professor emeritus at Keio University, Yonezawa is internationally famous for her research on amorphous systems. She was the first female president of the Physical Society of Japan.
It takes her about four hours door-to-door to get to her mother's house in Osaka, including the Shinkansen ride from Tokyo to Osaka. Her mother is bed-ridden and cannot turn herself over in bed. Yonezawa helps her younger sister, who lives with her mother and provides most of her care, do such things as changing her mother's diapers and dressing her.

As this summer was hot and humid, Yonezawa and her sister found themselves worn out after only washing a pile of laundry, such as towels and underwear. "My mother looked healthier than both of us," Yonezawa said. "She was absorbed in a kanji crossword puzzle she found in a magazine. Every time she solved one, she asked us for another one." Yonezawa, who continues to write and lecture in Tokyo, returns to her mother's house in Osaka about three times a month, for three to five days per visit.

In 2006, Toshiko began to have trouble walking because of osteoarthritis of the knee, and she began using a wheelchair. Her house, which she has been living in since she was 5 years old, had many uneven surfaces and had to be renovated to make it wheelchair-friendly. Yonezawa began visiting the Osaka house periodically immediately after the renovation.

In the summer of 2008, her mother was hospitalized for dehydration. She was discharged two weeks later, but her arms and legs had become weaker. "We put a call button by her bedside so she can call us from bed anytime," Yonezawa said. "She sweats a lot and uses the button to call us almost every hour at night, asking us to change her underwear.

"Sleepless nights for elderly people caring for elderly parents can shorten their own lives. My younger sister prepares three meals a day for mother, changes diapers and washes a mountain of laundry. If this continues, neither my sister nor I will be able to care for mother."

"In spite of the current circumstances, my sister, who is with our mother all the time, still gets exhausted," Yonezawa said. "But she and I both try to keep our spirits up. She is such a strong partner for me. But early this year, she confessed to me, 'I don't know whether I can last mentally and physically another year.' I had to listen to her silently. Her burden weighs on me heavily. I'm sorry to give her so much trouble.

Nursing Homes in Japan

Japanese families have traditionally taken care of their aging parents and sending them to nursing homes has been considered a cruel and irresponsible form of abandonment. Up until 1994, there was one paid nursing home with private rooms in all of Japan and it charged initiation fees of $1 million to $2 million.

Sociologist Kokichi Shoji told AFP, "Until the 1960s, Japanese had a code of ethic inherited from Confucianism which ensured that elderly breathed their last breath surrounded by their kids and kin. That's finished." With high housing costs for small dwelling, many Japanese simple don't have the money or the space for elderly relatives.

Japan has few nursing homes, which means that elderly Japanese who need moderate medical care have to go to hospitals that costs twice as much. Some old people check into hospitals simply because they lonely.

In 2002, nursing care insurance was introduced to reduce the burden on families who look after elderly relatives. It requires all Japanese 40 and over to pay special premiums used to provide nursing care if they need it after the age of 65. Already the system is being overwhelmed and premiums will probably have to be raised.

There have been a number of incidents involving elderly people and nursing care including abuse, suicide and even murder.

Graying Population and Social Services in Japan

Japan is aging faster than other nation: the result of the one world's smallest birth rates combined with the world's longest living people. The rate is twice as fast as in other industrialized countries.

Japan,” aging population will be a huge burden on social services. Health, welfare and social security costs rose 45 percent between 1991 and 2000 and expected to surge 100 percent by 2025. Hospitals are already overburdened with seniors who stay for months and nursing homes are in short supply. The costs of providing care is rising all the time. In 2000, 1.2 million were bedridden, half for three years or more.

The Japanese government has designated care of the elderly as one of the country's biggest problems. It is sometimes referred to as the "1-2-4" phenomena, a reference to families with one child, two parents and four grandparents.

The government offers a wide range of social services for older people in their homes, including providing workers who will cook meals and bath people who need help. In the future there is expected to be more demand for these kinds of services and their cost will be more of a strain on the government.

There is already a shortage of caregivers to take care of the elderly.

Coming Up with Extra Money for Nursing Care of the Elderly

Yonezawa and her sister now make use of a nursing-care helpers at night. But as the fees exceed the ceiling of the nursing-care insurance, they must pay for the help at night out of pocket. Yonezawa pays for the night care, but she is using her own savings to do so because her own pension benefits, even combined with her mother's, do not cover the costs of full-time night care.

"At first, I hesitated to ask for help at night," Yonezawa said. "I proposed to my sister that we hire a helper two nights a week, but she resisted because of the cost." Her sister finally relented when her fatigue continued to accumulate. They first hired care helpers for two nights a week, then three nights a week and then five nights. Several months later, they arranged for help every night. Yonezawa said she apologized to her sister for not getting full-time night care from the start.

Yonezawa uses every means she can to care for her mother, such as a service to bathe her at home, regular visits to a nursing-care facility and short stays in a nursing home. A total of about 30 people are involved in providing nursing care for her mother. "My husband died and my three children are economically independent, so I'm prepared to sell my Tokyo house if my savings run out," Yonezawa said.

"Nursing care relentlessly deprives families of money, time and physical and mental strength. We're anxious about the future--how long can we remain healthy? At this age, it exhausts me to even travel to Osaka with a personal computer. But I want to be with my mother and sister as long as I can. I can't help my sister enough, but I will try to empathize with her and lighten her burden."

Yonezawa's mother does not seem to care who changes her diapers. "Without realizing how expensive the nursing care is and how exhausted we are, mother innocently enjoys the crossword puzzles and writing haiku," Yonezawa said. "This is OK," she went on. "This is reality. But we are trying to strike a balance between caring for our mother and caring for ourselves. Recently, mother said she would live to be 108. My sister and I said with a laugh that we would both be long gone before that."

Depopulation of Rural Areas in Japan

Kaso, or de-population, is a big problem in the rural areas in Japan. Rural communities are shrinking as a result of migration to the cities, declining birth rates that have robbed rural areas of children and the trend for people to loose their bonds to their home towns and live where they please. Increased life spans have meant that the people that remain behind are getting older and older and dying off.

Rural areas are filled with old people. Kaso has caused the median age of Japanese farmers to rise from 42 in 1960 to 60 in 1990. Most of those who have stayed are first sons. In some towns the hospital, school, stores and many homes have been abandoned. The only place that is crowded is the cemetery. The elderly people that remain are hardy lot who continues to work outside and do many chores by hand.

Tens of thousands of villages have shrunk to shadows of their former selves. By one count 2,643 communities are considered to be on the brink of disappearing and have bene labeled as “endangered communities.” Another 60,000 are communities on the edge.” Hokkaido is particularly hard hit. By one estimate 9 percent of all communities there are endangered,

Communities are losing their bus services and public transportation because of a lack of passengers. Schools have shut down from a lack of children. Stores have closed. Health care facilities are far away. Farmers find its too expensive to transport their products and stop raising crops. People in their 90s are taken care of by offspring in their seventies.

Some villages are full of abandoned houses. Untended fields cover the site once occupied by a school. The only people in sight are 70 or older. Some of the most endangered villages are former fishing villages that have lost people as the fish stocks have declined. A typical fishing village in Hokkaido has shrunk from 10,000 people to 2,000, with four out of five people being pensioners and one forth over 75.

One elderly rural resident told the Los Angeles Times, "I've lived here 60 years and you're seeing fewer families all living together." His son lives in Tokyo and married daughter works several miles away. "And without jobs, more young people are moving away." [Source: Mark Magnier, Los Angeles Times, March 22, 2011]

Economic Costs of a Graying Population in Japan

Health care and nursing home costs in 2025 are expected to be almost $1 trillion, about 12 percent of GDP

A declining birthrate and an older population means that as time goes on there will more retired people and relatively less working people, which means that working people are increasingly called upon to support the retirees with their labor.

Between 1985 and 2005 the number old elderly doubled while the number of children fell by a third. By one count the Japanese workforce will shrink by 6.1 million by 2025. This will put a lot pressure on younger people to take care of older people. Japan will have allow large numbers of immigrants in if it wants to maintain economic growth.

The work force is expected to fall 15 percent over the next 20 years and halve in the next 50 years. Currently, about 70 percent of the population in Japan is of working age. By 2025, if current trends continue, the figure will drop to 60 percent. That means that in 2025 three working people will not only have to support themselves they also have to support two people who aren't working. By 2050 population loss will strip Japan of 70 percent of its workforce.

A shrinking, graying population is likely to cause the economy will shrink. There will be fewer skilled people entering the job market. There will be less savings. This means there will be less money for loans and investmnet and this will make it harder for companies to grow and create new jobs for young people.

Japan,” aging population is also widely seen as an obstacle to innovation. As the population gets older and fewer young people are born there are less young people around to come up with fresh new ideas and more cranky old people around to pooh pooh the fresh ideas that appear.

Japan will probably have allow large numbers of immigrants in if it wants to maintain economic growth.

Pensions and Social Security in Japan

There are currently two main pension systems: one for company workers and one for government workers. After it was revealed that government workers received preferential treatment in the government system---with the average public servants receiving ¥1.43 million more in additional pension payments than salaried workers---there was discussion about merging the pension systems.

Most Japan pay about a $100 a month into a pension system regardless of how much they earn. Self-employed sometimes don't pay into system Non-working housewives pay nothing into the social security system but are entitled to full pensions. Currently pensioners receive tax deductions.

Currently pension payments for a person who worked as company employee and was married to a person who did not work around is ¥233,000 a month, about 59 percent of an average monthly take home pay.

People over 75 are only required to pay 10 percent of medical costs incurred at hospitals. One municipality in Tokyo (Hinodemachi) has promised to provide free health care for the elderly starting in 2009.

Welfare for Older People in Japan

With advances in medical technology and improvements in public health and nutrition, the average life span of the Japanese people has markedly increased. As the elderly population expands, the number of bedridden and senile persons who require care is growing rapidly. By 2055 elderly people will account for 40.5 percent of the population in Japan, which means that one in 2.5 people will be 65 years or older. [Source: Web-Japan, Ministry of Foreign Affairs, Japan]

“The number of older Japanese requiring care will also rise as a result. Aggravating society,” care problem is the fact that the average family,” ability to provide such care is decreasing, partly because of the ongoing transition from extended to nuclear family patterns. In response to these circumstances, the government is reorganizing the welfare system for the elderly together with medical services for those elderly requiring care. As part of this reorganization, in 2000 a long-term care insurance system was inaugurated as a new social insurance system. Welfare measures for the benefit of elderly persons are carried out on the basis of the Social Welfare Service Law for the Elderly (Rojin Fukushi Ho), enacted in 1963. Provisions of the Health and Medical Service Law for the Elderly (Rojin Hoken Ho), enacted in 1982 are also relevant to maintaining and protecting elderly persons’ physical and mental health. [Ibid]

“Welfare measures for the benefit of elderly persons, together with those which benefit children and handicapped persons, are administered by local-governments, welfare offices (fukushi jimusho) in particular. To provide relevant assistance and advice, these offices employ certified social workers (shakai fukushi shuji) with specialized knowledge and skills. Working in collaboration are commissioned welfare volunteers (minsei iin), who try to gain an accurate understanding of the situation of elderly persons in their geographical areas and who assist the local welfare offices with their work. [Ibid]

“Welfare facilities for elderly persons needing special care include day service centers, nursing homes for the elderly (kaigo rojin hoken shisetsu), special nursing homes for the elderly (tokubetsu yogo rojin homu), and group homes for elderly with dementia (chihosei koreisha gurupu homu). To cope with the aging of society in the 21st century, the Japanese government instituted the Ten-Year Strategy to Promote Health Care and Welfare for the Elderly (commonly known as the Gold Plan) in 1989. This plan was revised in 1994 under the name New Gold Plan. The New Gold Plan made various improvements by fiscal 1999, including an increase in the number of home helpers for elderly persons, improvements in the capacity of short-stay facilities to accept them for periods of rest and special care, the offering of day services (including meals and physical exercise) at day service centers, and an expansion of at-home services such as visits by doctors and nurses who provide special care and guidance in physical exercises for regaining impaired functions. [Ibid]

“Three bills to create a long-term care insurance system for the elderly were approved in the Diet in December 1997, and the new system became effective in April 2000. Since then the use of most of the above-mentioned facilities and services has been provided via the long-term care insurance system. Another new plan, known as Gold Plan 21, was launched in 2000. The specific measures envisioned by this plan are: (1) improving the foundation of long-term care services, (2) promoting support measures for the senile elderly, (3) promoting measures to revitalize the elderly, (4) developing a support system in communities, (5) developing long-term care services which protect and are trusted by users, and (6) establishing a social foundation supporting the health and welfare of the elderly. [Ibid]

Pressure on Welfare System by Elderly with Low Pensions

Senior citizens aged 65 and older account for about 40 percent of welfare payment recipients--the largest among the various categories of recipients according to an article in the Yomiuri Shimbun . In just 10 years, the number of such older recipients increased by 340,000, to 690,000 in 2009. They account for 2.37 percent of the elderly population as a whole. This is markedly high when compared with 1.31 percent, which is the average proportion of welfare payment recipients among all generations. [Source: Yomiuri Shimbun, November 18, 2011]

"If they [the elderly] don't have savings or other assets, they simply can't live on the state pension alone," a caseworker in Tokyo told the Yomiuri Shimbun said. "If that's the case, there's nothing else but welfare payments." Pension benefits do not fully guarantee security in old age. Although 46.1 percent of elderly welfare recipients also receive a pension, the average amount is just 47,000 yen a month.

About 70 percent of elderly welfare recipients live alone. The rise in the number of welfare recipients can be partly explained by the decrease in the number of elderly people who live with their children. "The elderly have the highest risk of falling into poverty as they can't rely on financial assistance from their children," said Aya Abe, director of the Empirical Social Security Research Department of the National Institute of Population and Social Security Research. "The number of elderly recipients will increase as the nation's population gets older and the family structure changes."

In addition, the number of nonregular workers has been increasing and the percentage of those who are supposed to pay their national pension premiums but do not has risen to about 40 percent.When the current generation of working people reach old age, there will very likely be a large number of people whose pension will be low, or who will have no pension at all.

The government plans to carry out pension reform to deal with the problems of those living on low pensions, or no pension at all. Keio University Prof. Kohei Komamura, who specializes in social security, said, "It's time to discuss whether the minimum income of low-income elderly people should be guaranteed through pensions, or supported by the welfare benefit system."

Elderly Who Struggle with Low Pensions

In November 2011, the Yomiuri Shimbun reported: “The light from a TV is reflected on the face of a 77-year-old woman as she lies on her bed at night in her old apartment in Adachi Ward, Tokyo, which is owned by the metropolitan government. "To save on the cost of electricity, I only turn on the light when I go to the bathroom, even at night," she said.

For many years her husband, who died two years ago, used to work at a fruit and vegetable market. Four years ago, after he was forced to give up his job because of diabetes, they began to receive payments under the welfare benefit system. She currently receives a pension of about 50,000 yen a month, in addition to the welfare payments. Although she worked at a dry cleaning plant and had other jobs, she was barely able to put away any savings.

A 75-year-old woman living in a Tokyo rented apartment receives a monthly pension of about 30,000 yen. Because she repeatedly applied for exemption from making contributions earlier in her working life, due to her low income, she now only receives a reduced pension.She has a part-time job at a restaurant in Tokyo, where she once earned as much as 120,000 yen per month. However, she began to live on the welfare payments in June because her income fell.

"I didn't want to receive welfare payments, to tell the truth," she said. Her two sons work in the construction industry and have to pay large sums for the education of their children, who go to university and high school. When she told one of her sons that she had become eligible to receive welfare payments, he replied, "That's good, isn't it?"

Image Sources: Japan Zone

Text Sources: New York Times, Washington Post, Los Angeles Times, Daily Yomiuri, Times of London, Japan National Tourist Organization (JNTO), National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton,” Encyclopedia and various books and other publications.

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